A study published in the Hawaii Medical Journal this month links certain eye irritation symptoms, such as inflamed bumps on the inside of the eyelid and clear mucous discharge, to chronic exposure to vog, or volcanic fog, and its findings might be key in diagnosing and treating the condition.
"It’s important not just for the general population, but also for the health care practitioners to be aware that this condition exists, to identify it and to treat it early and effectively," said opthalmologist Jorge Camara, the study’s author.
Camara, who is associated with Surgicare of Hawaii, said he decided to study the condition — which he has named vog-induced conjunctivitis — because it is often misdiagnosed or not diagnosed at all because its symptoms are similar to other commonly diagnosed eye illnesses such as pink eye.
"The correct diagnosis is important because this is not an infectious problem," Camara said at a presentation of his findings Wednesday. "This will hopefully awaken a greater consciousness."
Camara said his study, titled "Ocular Findings in Volcanic Fog Induced Conjunctivitis," is the first of its kind, to the best of his knowledge, to be published in a peer-reviewed journal.
"To have a study of this magnitude … is going to have a lot of impact," Susan Senft, an ophthalmologist on Hawaii island, told Camara Wednesday. "It’s interesting to hear from your presentation how it affects, really, the entire state."
Senft said people in places with frequent volcanic activity, including Guatemala, Iceland and Washington state, might also benefit from the findings.
To participate in the non-comparative study, patients had to be living on Oahu for at least the past seven years and come in for an appointment complaining that vog was affecting their eyes.
"All the patients themselves were complaining about vog," Camara said.
Patients who had other allergies, were taking eye drops for other problems such as glaucoma that could redden their eyes or who had any other infections were not included.
Out of 45 possible candidates, 15 were ruled out for those reasons, leaving for the study a total number of 30 patients (20 women and 10 men between 18 and 85 years old). Patients seen between Jan. 3 and March 31 participated.
"If there was anything that we remotely felt could confuse the issue (it was left out)," Camara said.
From looking at their medical charts, he discovered that all the patients exhibited red eyes, inflamed bumps on the lining of their eyelids and clear mucous discharges. All also complained of itchiness and feeling that a foreign object was in their eye. Excessive tearing and burning were reported by 29 people and 27 people, respectively.
"You could feel the fire," Cecile Argel, a nurse and patient at Surgicare, said at the presentation Wednesday. Argel’s symptoms began in 1991 when she was living in the Philippines near Mount Pinatubo, which was erupting at the time.
Common symptoms recorded among patients complaining of vog irritation led Camara to conclude that these particular symptoms are related to vog exposure.
Next, Camara and his team studied the air composition over Oahu during the recording period to see if the symptoms could be linked to increased levels of vog.
The data obtained from the Clean Air Branch of the state Department of Health, which has monitoring stations in Honolulu, Pearl City, Kapolei and Sand Island, showed that between January and March, vog visibility was indeed higher than the rest of the year, as was the amount of particulate matter in the air.
"We came to the conclusion based on their complaints and based on what was in the environment, that these incidents were due to vog," Camara said. "Especially because we had excluded other causes."
With Kilauea, the world’s most active volcano, continuously erupting for the past 28 years, many residents — especially those on Oahu and Hawaii — suffer from severe and sometimes debilitating eye and respiratory irritation, Camara said.
"I had noticed over the last few years with increased frequency that patients were coming in complaining (that) vog was affecting their eyes," he said.
Oahu resident Virginia Jordan, who attended Camara’s presentation, said she had both of her tear ducts removed in 2002 after Camara found they had become blocked, which he said can result from long-term vog exposure.
Camara also discovered that symptoms worsen when tradewinds are at their weakest between December and March.
"Those tradewinds do make a difference," he said.
As with common allergies or hay fever, there is no cure for vog-induced conjunctivitis. Camara said he starts off new patients with a cold-compress routine to get the swelling down, prescribes a steroid eye drop if the symptoms are really bad, then treats them with a once-a-day antihistamine eye drop.
Jordan, who lives near Diamond Head and has traveled since 1990 to a vacation home near Hawaii Volcanoes National Park for several weeks each year, said she has learned how to manage her condition and stays indoors when she knows vog levels are high.
"If it’s just mist, the air is fresh; you feel like breathing it in," she said. "When it’s vog, I can tell the difference … when it’s really, really heavy, I can taste it."
Camara hopes his study will spark more research and lead to more early and effective diagnosis and treatment of the condition, as well as more information about what causes the condition and why certain people are more susceptible.
